The problem isn't with the percentages per se, it's with the complete demographic imbalance. Buffalo has more people on Medicaid as a percentage than any other city in America. Buffalo is also the poorest city (not in terms of GDP, business and the investment of the community in the city is relatively healthy up here) in terms of people living below the poverty line in the entire state of New York, a state with the most generous gov't health care in the country.

I want a single payer tax system. I want gov't care. But it would be best to do it nationally and have EVERYONE share in the burden. When you do it piecemeal, it doesn't work. When there's such a huge imbalance between the number of poor people and middle class people, then the local burden that you mention of 25% falls heavily on those paying the taxes. New York simply has more rich people as a percentage to poor people, so the medicaid mandate is much less of a burden.

People in Buffalo look at similar cities such as Providence and Pittsburgh and wonder, what's the difference? The answer isn't that we need more downstate funds. The answer is in restructuring gov't so that energy resources are shared equitably and also that the state regulations are more flexible. There are quite a few companies in Buffalo that apply for the energy credits every year, but those decisions are made by those with the political heft (i.e. not people from Western NY).